Michio Hongo - Academia.edu (original) (raw)
Papers by Michio Hongo
Japanese Journal of Smooth Muscle Research, 1988
![Research paper thumbnail of [Studies on the muscarine receptors in rat gastric smooth muscle]](https://attachments.academia-assets.com/93289419/thumbnails/1.jpg)
](Nippon Heikatsukin Gakkai zasshi
Japanese Journal of Smooth Muscle Research, 1990
The Tohoku Journal of Experimental Medicine, 1983
Lower esophageal sphincter pressure (LESP), gastric emptying, small bowel transit time and plasma... more Lower esophageal sphincter pressure (LESP), gastric emptying, small bowel transit time and plasma motilin levels were measured in diabetics and normal subjects in order to investigate the disturbances of the alimentary tract motility and the participation of motilin in these motility disorders. Hypermotilinemia was observed in all diabetics with or without autonomic neuropathy. Low response of LESP to tetragastrin found in diabetics with autonomic neuropathy could not be explained by motilin. Gastric emptying was highly correlated with fasting plasma motilin levels and a significantly accelerated gastric emptying observed in diabetics without complications or diabetics with diarrhea was considered to be due to hypermotilinemia. On the contrary, no significant correlation was observed between small bowel transit time and plasma motilin levels, suggesting no participation of endogenous motilin in the regulation of small bowel transit.-lower esophageal sphincter pressure; gastric emptying; small bowel transit time; motilin; diabetic autonomic neuropathy Disturbances of the alimentary tract motility have been observed frequently in the patients with diabetes mellitus. Swallowing disorder in diabetics with neuropathy-gastroenteropathy (Mandelstram et al. 1969), significantly fast gastric emptying of a liquid meal in diabetics without complications (Dotevall 1961), and delayed small bowel transit time in diabetics with autonomic neuropathy (Scarpello et al. 1976) have been reported to date. On the other hand, motilin, discovered by Brown et al. (Brown 1967; Brown et al. 1972), is well known to affect lower esophageal sphincter (Itoh et al. 1976), gastric emptying (Christofides et al. 1979, 1981) and small bowel transit time (Ruppin et al. 1976). Motilin has been considered to be one of the most important gut hormones affecting the
The Tohoku Journal of Experimental Medicine, 1980
Journal of Smooth Muscle Research, 1995
To investigate the alteration of the gastric electrical activities by aging, we performed electro... more To investigate the alteration of the gastric electrical activities by aging, we performed electrogastrography (EGG) on 13 asymptomatic young human subjects under 60 years old (the young group) and 12 subjects over 60 years (the elderly group). Surface EGG was recorded at fasting state for 30 minutes in each subject. We expressed the frequency distribution of surface EGG in each subject with the median value of frequency distribution (FMED) to represent the center of the electrical activities, and the interquartile range of frequency distribution (FIQR) as the indicator of regularity. FMED in the young group was 3.0: (median:[range]) cycles per minute (cpm), while it was 3.3:[3.0, 4.0] in the elderly group which showed statistically a significant difference between the groups (p= 0.01). FIQR in the young group was 0.5:[0.1, 1.8] and that in the elderly group was 0.55: which was not significantly different statistically. These data showed that aging increases the frequencies of the rhythm of surface EGG, without disturbing its regularity. This change may be a part of a spectrum of physiological changes accompanied with aging, and are unlikely to have clinico-pathological significance.
Journal of Gastroenterology and Hepatology, 2007
Background and Aims: Since the publication of the Asia-Pacific GERD consensus in 2004, more data ... more Background and Aims: Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidemiology and management of gastroesophageal reflux disease (GERD) have emerged. An evidence based review and update was needed. Methods: A multidisciplinary group developed consensus statements using the Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results: GERD is increasing in frequency in Asia. Risk factors include older age, male sex, race, family history, higher socioeconomic status, increased body mass index, and smoking. Symptomatic response to a proton pump inhibitor (PPI) test is diagnostic in patients with typical symptoms if alarm symptoms are absent. A negative pH study off therapy excludes GERD if a PPI test fails. The role for narrow band imaging, capsule endoscopy, and wireless pH monitoring has not yet been undefined. Diagnostic strategies in Asia must consider coexistent gastric cancer and peptic ulcer. Weight loss and elevation of head of bed improve reflux symptoms. PPIs are the most effective medical treatment. On-demand therapy is appropriate for nonerosive reflux disease (NERD) patients. Patients with chronic cough, laryngitis, and typical GERD symptoms should be offered twice daily PPI therapy after excluding non-GERD etiologies. Fundoplication could be offered to GERD patients when an experienced surgeon is available. Endoscopic treatment of GERD should not be offered outside clinical trials. Conclusions: Further studies are needed to clarify the role of newer diagnostic modalities and endoscopic therapy. Diagnostic strategies for GERD in Asia must consider coexistent gastric cancer and peptic ulcer. PPIs remain the cornerstone of therapy.
Journal of Gastroenterology and Hepatology, 2002
can be learnt from the patient. In the last decade, the 'Delphic' technique has been used to try ... more can be learnt from the patient. In the last decade, the 'Delphic' technique has been used to try and define combinations of symptoms in the belief, or hope, that specific symptom patterns correspond to specific underlying disorders. The 'Rome criteria' for the definition and diagnosis of functional gastrointestinal disorders have received much attention. Unfortunately, consensus of opinions by experts does not, per se, confer scientific validity. Evidence-based medicine requires not consensus, but evidence. We have reappraised the problem of classifying motor disorders by relying on what can be established by the detection of abnormal motor patterns, usually, but not invariably, associated with the altered movement of the contents of the digestive tube. In some, but not yet all, disorders, this approach is reinforced by identification of underlying pathological change in enteric innervation or musculature. While we remain aware that the association between symptoms-the perception that drives patients to seek help-and motor abnormalities is not always clear, we have taken the view that objectively reproducible alterations in organ function provide a robust basis for taxonomy. Such problems are not unique to gastroenterology; as an example, the association between dyspnea and specific pulmonary pathologies is not always clear, but dyspnea is a useful indication of abnormal respiratory function indicative of disease. Clinicians may feel dismayed that we have not elected to define two commonly used terms: 'functional dys
Journal of Gastroenterology and Hepatology, 2010
Background and Aims: Many of the ideas on irritable bowel syndrome (IBS) are derived from studies... more Background and Aims: Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. Methods: A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. Results: We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. Conclusions: This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.
Journal of Gastroenterology, 1998
Duodenal gastrinoma is recognized as a relatively common cause of Zollinger-Ellison syndrome, but... more Duodenal gastrinoma is recognized as a relatively common cause of Zollinger-Ellison syndrome, but its clinical and biological features are not well known. Here we report a case of duodenal gastrinoma with lymph node metastasis which was confirmed by pathology examinations. Hypergastrinemia and gastric acid hypersecretion were documented, but the secretin test showed negative results. An enlarged peripancreatic lymph node lying close to the pancreas head was the only positive finding on preoperative imaging studies. The results of the selective arterial secretin injection (SASI) test suggested that the primary tumor was located in the gastrinoma triangle. Finally, surgical exploration was carried out and a submucosal tumor, approximately 15 mm in size, was detected by intraoperative palpation at the posterior wall of the proximal portion of the duodenum. Intraoperative pathology examination demonstrated metastases to regional lymph nodes. The present case calls attention to the unique features of duodenal gastrinomas, which differ from those of pancreatic origin: a highly malignant potential for its small size, and submucosal location in the proximal duodenum. The SASI test is recommended for assessing the location of a primary lesion if it cannot be identified by various conventional imaging studies.
Internal Medicine, 2011
Objective The comorbid conditions questionnaire (CCQ) and the recent physical symptoms questionna... more Objective The comorbid conditions questionnaire (CCQ) and the recent physical symptoms questionnaire (RPSQ) have been validated in the US for the evaluation of comorbid physical conditions in patients with irritable bowel syndrome (IBS). A lack of instruments to assess somatization in Japanese subjects with IBS warrants development of the Japanese versions of these questionnaires. The purpose of this study was to validate the Japanese versions created, the CCQ-J and RPSQ-J. Methods and Patients Study 1 was carried out to verify the test-retest reliability and internal consistency of the CCQ-J and RPSQ-J in 49 patients with functional bowel disorder. Study 2 was performed to confirm the construct validities of these questionnaires compared to the Cornell Medical Index (CMI) in 120 patients with psychosomatic symptoms (assigned to the somatoform disorder, anxiety disorder, depressive disorder, or IBS group) and 22 healthy subjects. Results In Study 1, high reproducibility and high intraclass correlation coefficients were demonstrated for these questionnaires. In Study 2, total score on the CMI was significantly associated with score on the CCQ-J and on the RPSQ-J in the IBS group. The proportion of patients with chronic back pain was significantly higher in the IBS group than in controls (27.3% vs. 18.5%, p<0.05). Conclusion The CCQ-J and RPSQ-J are valid and reliable instruments for evaluating comorbid conditions in Japanese patients with IBS. Further studies are needed to confirm the direct cross-cultural comparison of the impact of somatization in IBS between different countries.
Gut, 2011
Objective To determine the efficacy of acotiamide, an acetylcholinesterase inhibitor, in patients... more Objective To determine the efficacy of acotiamide, an acetylcholinesterase inhibitor, in patients with functional dyspepsia (FD) in a 4-week trial Methods A multicentre, randomised, placebocontrolled, parallel-group, phase III trial was carried out, in which patients with FD received 100 mg of acotiamide or placebo three times a day for 4 weeks, with 4 weeks post-treatment follow-up. The primary efficacy end points were global assessment of overall treatment efficacy (OTE) and elimination rate of all three mealrelated symptoms (postprandial fullness, upper abdominal bloating and early satiation), as derived from daily diaries. Secondary efficacy end points were individual symptom scores and quality of life. Adverse events were monitored. Results 52.2% of those receiving acotiamide and 34.8% in the placebo group (p<0.001) were classified as responders according to a global assessment of OTE. Over 4 weeks, the elimination rate for all three mealrelated symptoms was 15.3% among patients receiving acotiamide compared with 9.0% in the placebo group (p¼0.004). The significant benefit of acotiamide over placebo in OTE and elimination rate was maintained during the 4 week post-treatment follow-up. All other secondary efficacy end points, including quality of life, were significantly improved with 100 mg of acotiamide as compared with placebo. The number needed to treat was 6 for OTE and 16 for symptom elimination rate. The incidence of adverse events was similar between the acotiamide group and placebo group and no significant cardiovascular effects due to treatment were seen. Conclusions Over 4 weeks, acotiamide significantly improved symptom severity and eliminated meal-related symptoms in patients with FD. Trial registration number http://ClinicalTrials.gov number, NCT00761358.
Gut, 1998
Background—Corticotropin-releasing hormone (CRH) plays a key role in modulating intestinal motili... more Background—Corticotropin-releasing hormone (CRH) plays a key role in modulating intestinal motility in stressed animals.Aims—To evaluate the effect of CRH on intestinal motility in humans and to determine whether patients with irritable bowel syndrome (IBS) have an exaggerated response to CRH.Subjects—Ten IBS patients diagnosed by Rome criteria and 10 healthy controls.Methods—CRH (2 μg/kg) was intravenously administered during duodenal and colonic manometry and plasma adrenocorticotropic hormone (ACTH) was measured by radioimmunoassay.Results—CRH induced motility of the descending colon in both groups (p<0.001) and induced greater motility indexes in IBS patients than in controls (p<0.05). CRH produced duodenal phase III motor activity in 80% of the subjects and duodenal dysmotility in 40% of IBS patients. Abdominal symptoms evoked by CRH in IBS patients lasted significantly longer than those in controls (p<0.05). CRH induced significant increases in plasma ACTH levels in b...
Gut, 1999
BACKGROUNDEndoscopic oesophageal changes are diagnostically helpful and identify patients exposed... more BACKGROUNDEndoscopic oesophageal changes are diagnostically helpful and identify patients exposed to the risk of disease chronicity. However, there is a serious lack of agreement about how to describe and classify the appearance of reflux oesophagitisAIMSTo examine the reliability of criteria that describe the circumferential extent of mucosal breaks and to evaluate the functional and clinical correlates of patients with reflux disease whose oesophagitis was graded according to the Los Angeles system.METHODSForty six endoscopists from different countries used a detailed worksheet to evaluate endoscopic video recordings from 22 patients with the full range of severity of reflux oesophagitis. In separate studies, Los Angeles system gradings were correlated with 24 hour oesophageal pH monitoring (178 patients), and with clinical trials of omeprazole treatment (277 patients).RESULTSEvaluation of circumferential extent of oesophagitis by the criterion of whether mucosal breaks extended b...
BioPsychoSocial Medicine, 2007
Aims To compare quality of life (QOL) for patients with irritable bowel syndrome (IBS) between th... more Aims To compare quality of life (QOL) for patients with irritable bowel syndrome (IBS) between the U.S. and Japan, it is indispensable to develop common instruments. The IBS-QOL, which is widely used in Western countries, was translated into Japanese as there has been a lack of Japanese disease-specific QOL measures for IBS. Methods The original 34 items of the IBS-QOL were translated from English into Japanese through two independent forward translations, resolution, back translation, and resolution of differences. Forty nine patients who had GI symptoms but did not have any organic diseases (including 30 IBS patients diagnosed by Rome II criteria) were recruited from Tohoku University Hospital in Sendai, Japan and completed a Japanese version of the IBS-QOL (IBS-QOL-J) concomitant with a Japanese version of the IBS severity index (IBSSI-J) twice within 7–14 days. Results The IBS-QOL-J demonstrated high internal consistency (Cronbach's alpha; 0.96) and high reproducibility (int...
Digestion, 2011
Background: This long-term 48-week study of acotiamide was carried out to investigate the efficac... more Background: This long-term 48-week study of acotiamide was carried out to investigate the efficacy, safety and administration pattern in patients with functional dyspepsia (FD). Methods: This was a multicenter, open-label, single-arm, long-term phase III study in which patients with FD were given acotiamide, 100 mg t.i.d., for 48 weeks. The two major efficacy endpoints were global overall treatment efficacy (OTE) and the elimination rate of three cardinal symptoms (i.e. postprandial fullness, early satiation and upper abdominal bloating), which were evaluated weekly and daily by the patients, respectively. The long-term administration patterns were investigated by following the patients based on cessation and readministration criteria. Results: Efficacy was analyzed in 405 patients. The OTE improvement rate was 26.1% at week 1 and increased with time. It was 60.6% at week 8 and subsequently maintained. Similarly, the symptom elimination rate increased up to week 8. Many patients who...
Journal of smooth …, 1996
To clarify the changes of esophageal motility along with age, we performed esophageal manometry o... more To clarify the changes of esophageal motility along with age, we performed esophageal manometry on 47 healthy volunteers, and compared the values of four groups under 49 years old (n= 11), 50 to 59 (n= 15), 60 to 69 (n= 11), and over 70 years old (n= 10). ...
Journal of Gastroenterology and Hepatology, 2007
Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidem... more Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidemiology and management of gastroesophageal reflux disease (GERD) have emerged. An evidence based review and update was needed. Methods: A multidisciplinary group developed consensus statements using the Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results: GERD is increasing in frequency in Asia. Risk factors include older age, male sex, race, family history, higher socioeconomic status, increased body mass index, and smoking. Symptomatic response to a proton pump inhibitor (PPI) test is diagnostic in patients with typical symptoms if alarm symptoms are absent. A negative pH study off therapy excludes GERD if a PPI test fails. The role for narrow band imaging, capsule endoscopy, and wireless pH monitoring has not yet been undefined. Diagnostic strategies in Asia must consider coexistent gastric cancer and peptic ulcer. Weight loss and elevation of head of bed improve reflux symptoms. PPIs are the most effective medical treatment. On-demand therapy is appropriate for nonerosive reflux disease (NERD) patients. Patients with chronic cough, laryngitis, and typical GERD symptoms should be offered twice daily PPI therapy after excluding non-GERD etiologies. Fundoplication could be offered to GERD patients when an experienced surgeon is available. Endoscopic treatment of GERD should not be offered outside clinical trials. Conclusions: Further studies are needed to clarify the role of newer diagnostic modalities and endoscopic therapy. Diagnostic strategies for GERD in Asia must consider coexistent gastric cancer and peptic ulcer. PPIs remain the cornerstone of therapy.
Japanese Journal of Smooth Muscle Research, 1988
Nippon Heikatsukin Gakkai zasshi
Japanese Journal of Smooth Muscle Research, 1990
The Tohoku Journal of Experimental Medicine, 1983
Lower esophageal sphincter pressure (LESP), gastric emptying, small bowel transit time and plasma... more Lower esophageal sphincter pressure (LESP), gastric emptying, small bowel transit time and plasma motilin levels were measured in diabetics and normal subjects in order to investigate the disturbances of the alimentary tract motility and the participation of motilin in these motility disorders. Hypermotilinemia was observed in all diabetics with or without autonomic neuropathy. Low response of LESP to tetragastrin found in diabetics with autonomic neuropathy could not be explained by motilin. Gastric emptying was highly correlated with fasting plasma motilin levels and a significantly accelerated gastric emptying observed in diabetics without complications or diabetics with diarrhea was considered to be due to hypermotilinemia. On the contrary, no significant correlation was observed between small bowel transit time and plasma motilin levels, suggesting no participation of endogenous motilin in the regulation of small bowel transit.-lower esophageal sphincter pressure; gastric emptying; small bowel transit time; motilin; diabetic autonomic neuropathy Disturbances of the alimentary tract motility have been observed frequently in the patients with diabetes mellitus. Swallowing disorder in diabetics with neuropathy-gastroenteropathy (Mandelstram et al. 1969), significantly fast gastric emptying of a liquid meal in diabetics without complications (Dotevall 1961), and delayed small bowel transit time in diabetics with autonomic neuropathy (Scarpello et al. 1976) have been reported to date. On the other hand, motilin, discovered by Brown et al. (Brown 1967; Brown et al. 1972), is well known to affect lower esophageal sphincter (Itoh et al. 1976), gastric emptying (Christofides et al. 1979, 1981) and small bowel transit time (Ruppin et al. 1976). Motilin has been considered to be one of the most important gut hormones affecting the
The Tohoku Journal of Experimental Medicine, 1980
Journal of Smooth Muscle Research, 1995
To investigate the alteration of the gastric electrical activities by aging, we performed electro... more To investigate the alteration of the gastric electrical activities by aging, we performed electrogastrography (EGG) on 13 asymptomatic young human subjects under 60 years old (the young group) and 12 subjects over 60 years (the elderly group). Surface EGG was recorded at fasting state for 30 minutes in each subject. We expressed the frequency distribution of surface EGG in each subject with the median value of frequency distribution (FMED) to represent the center of the electrical activities, and the interquartile range of frequency distribution (FIQR) as the indicator of regularity. FMED in the young group was 3.0: (median:[range]) cycles per minute (cpm), while it was 3.3:[3.0, 4.0] in the elderly group which showed statistically a significant difference between the groups (p= 0.01). FIQR in the young group was 0.5:[0.1, 1.8] and that in the elderly group was 0.55: which was not significantly different statistically. These data showed that aging increases the frequencies of the rhythm of surface EGG, without disturbing its regularity. This change may be a part of a spectrum of physiological changes accompanied with aging, and are unlikely to have clinico-pathological significance.
Journal of Gastroenterology and Hepatology, 2007
Background and Aims: Since the publication of the Asia-Pacific GERD consensus in 2004, more data ... more Background and Aims: Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidemiology and management of gastroesophageal reflux disease (GERD) have emerged. An evidence based review and update was needed. Methods: A multidisciplinary group developed consensus statements using the Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results: GERD is increasing in frequency in Asia. Risk factors include older age, male sex, race, family history, higher socioeconomic status, increased body mass index, and smoking. Symptomatic response to a proton pump inhibitor (PPI) test is diagnostic in patients with typical symptoms if alarm symptoms are absent. A negative pH study off therapy excludes GERD if a PPI test fails. The role for narrow band imaging, capsule endoscopy, and wireless pH monitoring has not yet been undefined. Diagnostic strategies in Asia must consider coexistent gastric cancer and peptic ulcer. Weight loss and elevation of head of bed improve reflux symptoms. PPIs are the most effective medical treatment. On-demand therapy is appropriate for nonerosive reflux disease (NERD) patients. Patients with chronic cough, laryngitis, and typical GERD symptoms should be offered twice daily PPI therapy after excluding non-GERD etiologies. Fundoplication could be offered to GERD patients when an experienced surgeon is available. Endoscopic treatment of GERD should not be offered outside clinical trials. Conclusions: Further studies are needed to clarify the role of newer diagnostic modalities and endoscopic therapy. Diagnostic strategies for GERD in Asia must consider coexistent gastric cancer and peptic ulcer. PPIs remain the cornerstone of therapy.
Journal of Gastroenterology and Hepatology, 2002
can be learnt from the patient. In the last decade, the 'Delphic' technique has been used to try ... more can be learnt from the patient. In the last decade, the 'Delphic' technique has been used to try and define combinations of symptoms in the belief, or hope, that specific symptom patterns correspond to specific underlying disorders. The 'Rome criteria' for the definition and diagnosis of functional gastrointestinal disorders have received much attention. Unfortunately, consensus of opinions by experts does not, per se, confer scientific validity. Evidence-based medicine requires not consensus, but evidence. We have reappraised the problem of classifying motor disorders by relying on what can be established by the detection of abnormal motor patterns, usually, but not invariably, associated with the altered movement of the contents of the digestive tube. In some, but not yet all, disorders, this approach is reinforced by identification of underlying pathological change in enteric innervation or musculature. While we remain aware that the association between symptoms-the perception that drives patients to seek help-and motor abnormalities is not always clear, we have taken the view that objectively reproducible alterations in organ function provide a robust basis for taxonomy. Such problems are not unique to gastroenterology; as an example, the association between dyspnea and specific pulmonary pathologies is not always clear, but dyspnea is a useful indication of abnormal respiratory function indicative of disease. Clinicians may feel dismayed that we have not elected to define two commonly used terms: 'functional dys
Journal of Gastroenterology and Hepatology, 2010
Background and Aims: Many of the ideas on irritable bowel syndrome (IBS) are derived from studies... more Background and Aims: Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. Methods: A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. Results: We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. Conclusions: This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.
Journal of Gastroenterology, 1998
Duodenal gastrinoma is recognized as a relatively common cause of Zollinger-Ellison syndrome, but... more Duodenal gastrinoma is recognized as a relatively common cause of Zollinger-Ellison syndrome, but its clinical and biological features are not well known. Here we report a case of duodenal gastrinoma with lymph node metastasis which was confirmed by pathology examinations. Hypergastrinemia and gastric acid hypersecretion were documented, but the secretin test showed negative results. An enlarged peripancreatic lymph node lying close to the pancreas head was the only positive finding on preoperative imaging studies. The results of the selective arterial secretin injection (SASI) test suggested that the primary tumor was located in the gastrinoma triangle. Finally, surgical exploration was carried out and a submucosal tumor, approximately 15 mm in size, was detected by intraoperative palpation at the posterior wall of the proximal portion of the duodenum. Intraoperative pathology examination demonstrated metastases to regional lymph nodes. The present case calls attention to the unique features of duodenal gastrinomas, which differ from those of pancreatic origin: a highly malignant potential for its small size, and submucosal location in the proximal duodenum. The SASI test is recommended for assessing the location of a primary lesion if it cannot be identified by various conventional imaging studies.
Internal Medicine, 2011
Objective The comorbid conditions questionnaire (CCQ) and the recent physical symptoms questionna... more Objective The comorbid conditions questionnaire (CCQ) and the recent physical symptoms questionnaire (RPSQ) have been validated in the US for the evaluation of comorbid physical conditions in patients with irritable bowel syndrome (IBS). A lack of instruments to assess somatization in Japanese subjects with IBS warrants development of the Japanese versions of these questionnaires. The purpose of this study was to validate the Japanese versions created, the CCQ-J and RPSQ-J. Methods and Patients Study 1 was carried out to verify the test-retest reliability and internal consistency of the CCQ-J and RPSQ-J in 49 patients with functional bowel disorder. Study 2 was performed to confirm the construct validities of these questionnaires compared to the Cornell Medical Index (CMI) in 120 patients with psychosomatic symptoms (assigned to the somatoform disorder, anxiety disorder, depressive disorder, or IBS group) and 22 healthy subjects. Results In Study 1, high reproducibility and high intraclass correlation coefficients were demonstrated for these questionnaires. In Study 2, total score on the CMI was significantly associated with score on the CCQ-J and on the RPSQ-J in the IBS group. The proportion of patients with chronic back pain was significantly higher in the IBS group than in controls (27.3% vs. 18.5%, p<0.05). Conclusion The CCQ-J and RPSQ-J are valid and reliable instruments for evaluating comorbid conditions in Japanese patients with IBS. Further studies are needed to confirm the direct cross-cultural comparison of the impact of somatization in IBS between different countries.
Gut, 2011
Objective To determine the efficacy of acotiamide, an acetylcholinesterase inhibitor, in patients... more Objective To determine the efficacy of acotiamide, an acetylcholinesterase inhibitor, in patients with functional dyspepsia (FD) in a 4-week trial Methods A multicentre, randomised, placebocontrolled, parallel-group, phase III trial was carried out, in which patients with FD received 100 mg of acotiamide or placebo three times a day for 4 weeks, with 4 weeks post-treatment follow-up. The primary efficacy end points were global assessment of overall treatment efficacy (OTE) and elimination rate of all three mealrelated symptoms (postprandial fullness, upper abdominal bloating and early satiation), as derived from daily diaries. Secondary efficacy end points were individual symptom scores and quality of life. Adverse events were monitored. Results 52.2% of those receiving acotiamide and 34.8% in the placebo group (p<0.001) were classified as responders according to a global assessment of OTE. Over 4 weeks, the elimination rate for all three mealrelated symptoms was 15.3% among patients receiving acotiamide compared with 9.0% in the placebo group (p¼0.004). The significant benefit of acotiamide over placebo in OTE and elimination rate was maintained during the 4 week post-treatment follow-up. All other secondary efficacy end points, including quality of life, were significantly improved with 100 mg of acotiamide as compared with placebo. The number needed to treat was 6 for OTE and 16 for symptom elimination rate. The incidence of adverse events was similar between the acotiamide group and placebo group and no significant cardiovascular effects due to treatment were seen. Conclusions Over 4 weeks, acotiamide significantly improved symptom severity and eliminated meal-related symptoms in patients with FD. Trial registration number http://ClinicalTrials.gov number, NCT00761358.
Gut, 1998
Background—Corticotropin-releasing hormone (CRH) plays a key role in modulating intestinal motili... more Background—Corticotropin-releasing hormone (CRH) plays a key role in modulating intestinal motility in stressed animals.Aims—To evaluate the effect of CRH on intestinal motility in humans and to determine whether patients with irritable bowel syndrome (IBS) have an exaggerated response to CRH.Subjects—Ten IBS patients diagnosed by Rome criteria and 10 healthy controls.Methods—CRH (2 μg/kg) was intravenously administered during duodenal and colonic manometry and plasma adrenocorticotropic hormone (ACTH) was measured by radioimmunoassay.Results—CRH induced motility of the descending colon in both groups (p<0.001) and induced greater motility indexes in IBS patients than in controls (p<0.05). CRH produced duodenal phase III motor activity in 80% of the subjects and duodenal dysmotility in 40% of IBS patients. Abdominal symptoms evoked by CRH in IBS patients lasted significantly longer than those in controls (p<0.05). CRH induced significant increases in plasma ACTH levels in b...
Gut, 1999
BACKGROUNDEndoscopic oesophageal changes are diagnostically helpful and identify patients exposed... more BACKGROUNDEndoscopic oesophageal changes are diagnostically helpful and identify patients exposed to the risk of disease chronicity. However, there is a serious lack of agreement about how to describe and classify the appearance of reflux oesophagitisAIMSTo examine the reliability of criteria that describe the circumferential extent of mucosal breaks and to evaluate the functional and clinical correlates of patients with reflux disease whose oesophagitis was graded according to the Los Angeles system.METHODSForty six endoscopists from different countries used a detailed worksheet to evaluate endoscopic video recordings from 22 patients with the full range of severity of reflux oesophagitis. In separate studies, Los Angeles system gradings were correlated with 24 hour oesophageal pH monitoring (178 patients), and with clinical trials of omeprazole treatment (277 patients).RESULTSEvaluation of circumferential extent of oesophagitis by the criterion of whether mucosal breaks extended b...
BioPsychoSocial Medicine, 2007
Aims To compare quality of life (QOL) for patients with irritable bowel syndrome (IBS) between th... more Aims To compare quality of life (QOL) for patients with irritable bowel syndrome (IBS) between the U.S. and Japan, it is indispensable to develop common instruments. The IBS-QOL, which is widely used in Western countries, was translated into Japanese as there has been a lack of Japanese disease-specific QOL measures for IBS. Methods The original 34 items of the IBS-QOL were translated from English into Japanese through two independent forward translations, resolution, back translation, and resolution of differences. Forty nine patients who had GI symptoms but did not have any organic diseases (including 30 IBS patients diagnosed by Rome II criteria) were recruited from Tohoku University Hospital in Sendai, Japan and completed a Japanese version of the IBS-QOL (IBS-QOL-J) concomitant with a Japanese version of the IBS severity index (IBSSI-J) twice within 7–14 days. Results The IBS-QOL-J demonstrated high internal consistency (Cronbach's alpha; 0.96) and high reproducibility (int...
Digestion, 2011
Background: This long-term 48-week study of acotiamide was carried out to investigate the efficac... more Background: This long-term 48-week study of acotiamide was carried out to investigate the efficacy, safety and administration pattern in patients with functional dyspepsia (FD). Methods: This was a multicenter, open-label, single-arm, long-term phase III study in which patients with FD were given acotiamide, 100 mg t.i.d., for 48 weeks. The two major efficacy endpoints were global overall treatment efficacy (OTE) and the elimination rate of three cardinal symptoms (i.e. postprandial fullness, early satiation and upper abdominal bloating), which were evaluated weekly and daily by the patients, respectively. The long-term administration patterns were investigated by following the patients based on cessation and readministration criteria. Results: Efficacy was analyzed in 405 patients. The OTE improvement rate was 26.1% at week 1 and increased with time. It was 60.6% at week 8 and subsequently maintained. Similarly, the symptom elimination rate increased up to week 8. Many patients who...
Journal of smooth …, 1996
To clarify the changes of esophageal motility along with age, we performed esophageal manometry o... more To clarify the changes of esophageal motility along with age, we performed esophageal manometry on 47 healthy volunteers, and compared the values of four groups under 49 years old (n= 11), 50 to 59 (n= 15), 60 to 69 (n= 11), and over 70 years old (n= 10). ...
Journal of Gastroenterology and Hepatology, 2007
Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidem... more Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidemiology and management of gastroesophageal reflux disease (GERD) have emerged. An evidence based review and update was needed. Methods: A multidisciplinary group developed consensus statements using the Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results: GERD is increasing in frequency in Asia. Risk factors include older age, male sex, race, family history, higher socioeconomic status, increased body mass index, and smoking. Symptomatic response to a proton pump inhibitor (PPI) test is diagnostic in patients with typical symptoms if alarm symptoms are absent. A negative pH study off therapy excludes GERD if a PPI test fails. The role for narrow band imaging, capsule endoscopy, and wireless pH monitoring has not yet been undefined. Diagnostic strategies in Asia must consider coexistent gastric cancer and peptic ulcer. Weight loss and elevation of head of bed improve reflux symptoms. PPIs are the most effective medical treatment. On-demand therapy is appropriate for nonerosive reflux disease (NERD) patients. Patients with chronic cough, laryngitis, and typical GERD symptoms should be offered twice daily PPI therapy after excluding non-GERD etiologies. Fundoplication could be offered to GERD patients when an experienced surgeon is available. Endoscopic treatment of GERD should not be offered outside clinical trials. Conclusions: Further studies are needed to clarify the role of newer diagnostic modalities and endoscopic therapy. Diagnostic strategies for GERD in Asia must consider coexistent gastric cancer and peptic ulcer. PPIs remain the cornerstone of therapy.